COVID-19-associated coagulopathy and disseminated intravascular coagulation
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PROGRESS IN HEMATOLOGY Advances in diagnosis and treatment of disseminated intravascular coagulation
COVID‑19‑associated coagulopathy and disseminated intravascular coagulation Hidesaku Asakura1 · Haruhiko Ogawa2 Received: 15 October 2020 / Revised: 15 October 2020 / Accepted: 22 October 2020 © Japanese Society of Hematology 2020
Abstract The pathology of coronavirus disease 2019 (COVID-19) is exacerbated by the progression of thrombosis, and disseminated intravascular coagulation (DIC), and cytokine storms. The most frequently reported coagulation/fibrinolytic abnormality in COVID-19 is the increase in d-dimer, and its relationship with prognosis has been discussed. However, limits exist to the utility of evaluation by d-dimer alone. In addition, since the coagulation/fibrinolytic condition sometimes fluctuates within a short period of time, regular examinations in recognition of the significance of the examination are desirable. The pathophysiology of disseminated intravascular coagulation (DIC) associated with COVID-19 is very different from that of septic DIC, and both thrombotic and hemorrhagic pathologies should be noted. COVID-19 thrombosis includes macro- and microthrombosis, with diagnosis of the latter depending on markers of coagulation and fibrinolysis. Treatment of COVID19 is classified into antiviral treatment, cytokine storm treatment, and thrombosis treatment. Rather than providing uniform treatment, the treatment method most suitable for the severity and stage should be selected. Combination therapy with heparin and nafamostat is expected to develop in the future. Fibrinolytic therapy and adsorption therapy require further study Keywords COVID-19 · Thrombosis · Disseminated intravascular coagulation · DIC · Cytokine storm · SARS-CoV-2
Introduction Coronavirus disease 2019 (COVID-19) is an infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eighty percent of infected individuals are asymptomatic or show only mild symptoms, but 20% of infected individuals become severely ill and 2–5% die. Men are well known to be infected more frequently than women, and the elderly and patients with comorbidities (such as cardiovascular disease, hypertension, diabetes, and obesity) are more likely to develop more severe disease [1–3]. However,
* Hidesaku Asakura [email protected]‑u.ac.jp Haruhiko Ogawa h‑[email protected] 1
Department of Hematology, Kanazawa University Hospital, Takaramachi 13‑1, Kanazawa, Ishikawa 920‑8640, Japan
Department of Environmental and Preventive Medicine, Kanazawa University, Takaramachi 13‑1, Kanazawa, Ishikawa 920‑8640, Japan
2
severe disease can develop even in young people and those without comorbidities, and many points remain unclear regarding what factors contribute to the outcomes. Some genetic components may also be involved. In fact, sex differences have been reported in immunological responses to SARS-CoV-2 [4] and that relatively few people with blood type O are infected [5]. Respiratory failure is the most common cause of d
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